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The Effects of Proficiency and Bias on Residents’ Interpretation of the Microscopic Urinalysis

Author

Listed:
  • Stephen D. Flach

    (University of Iowa College of Medicine and Public Policy Center, Iowa City, Iowa)

  • Gay J. Canaris

    (Section of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska)

  • Thomas G. Tape

    (Section of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska)

  • Kathryn M. Huntley

    (Skyline Hospital, White Salmon, Washington)

  • Robert S. Wigton

    (Section of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska)

Abstract

Objective . This study aims to determine whether residents are influenced by clinical information when interpreting microscopic urinalysis (UA) and estimating the probability of a urinary tract infection (UTI), and to determine the accuracy and reliability of UA readings. Design . Residents estimated the UA white blood cell count and the probability of a UTI in vignettes using a fractional factorial design, varying symptoms, gender, and the white blood cell count on preprepared urine slides. Results . Individual-level results indicated a clinical information bias and poor accuracy. Seventeen of 38 residents increased the white blood cell count in response to female gender; 14 increased the white blood cell count in response to UTI symptoms. Forty-nine percent of the readings were inaccurate; agreement ranged from 50% to 67% for white and red blood cells and bacteria. Conclusion . Many residents gave inaccurate UA readings, and many readings varied with clinical information. A significant portion of residents needs assistance in objectively and accurately interpreting the UA.

Suggested Citation

  • Stephen D. Flach & Gay J. Canaris & Thomas G. Tape & Kathryn M. Huntley & Robert S. Wigton, 2002. "The Effects of Proficiency and Bias on Residents’ Interpretation of the Microscopic Urinalysis," Medical Decision Making, , vol. 22(4), pages 318-325, August.
    • Handle: RePEc:sae:medema:v:22:y:2002:i:4:p:318-325
    DOI: 10.1177/0272989X0202200410
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